Monthly Archives: March 2014

Calorie Counts at Restaurants: TMI?


In the article discussing public health initiatives to combat obesity and their ethicality, Holm argues that there are three different forms of paternalism: hard paternalism (direct coercion), soft paternalism (giving unwanted information or foreclosing some options for action), and maternalism (control by inducing a guilty conscience). He then applies these types of paternalism to a discussion of the ethics behind obesity interventions. The first question is whether it is justifiable to promote a person’s own health or well-being, if they do not want intervention. I immediately thought of the ethicality of posting calorie counts at restaurants. If the person does not want the information, this is most definitely a form of soft paternalism, and even a little bit of maternalism as guilt may prevent someone from ordering what they want. But is it justified? 

Recent Studies 

Recent studies have found that while an estimated 15% of restaurant customers used calorie listings to help them choose healthier foods, the majority of listings were too confusing to guide diners to make healthier decisions.  Programs like these often encourage businesses to work towards putting healthier and more nutritious items on their menus as they know that customers will be provided with the nutritional facts in an easy and convenient way. For example, it is embarrassing for McDonald’s to have to disclose that 20 Chicken McNuggets is 860 calories. Thus this provides both an incentive for business owners to provide healthier alternatives as well for consumers to make healthier eating decisions.

Autonomous Decision Making 

Misinformation, along with busy lifestyles and too many unhealthy choices, has been pegged as one of the leading causes of the obesity epidemic. In order for consumers to make a fully autonomous decision based on informed choices, they must have enough information to do so. While it is likely that the calorie listings encourage people to make healthier decisions, the information provided is in no way biased. The calorie listings are simply stating the facts and thus I don’t think it is fair to view them as a bias or a source of forced paternalism. I think the main question is whether or not society or the state is justified in interfering in our personal choices. But is it really interfering if they are only helping us make a more well informed decision? I argue that no. The displays of calorie values are ethical as well as important to the health of our society.  There is no loss of freedom or autonomy in being provided the extra information, in fact autonomy is actually increased as more information allows one to form a better informed decision.

Demmers, Thea. “Opinion: Should Restaurants Be Forced to List Calorie Counts? No.” Montreal Gazetter, 26 Mar. 2014. Web. 31 Mar. 2014.
Hill, Valerie. “Researcher Argues Lifestyle Changes Key to Preventing Cancer.” The Record, 30 Mar. 2014. Web. 31 Mar. 2014.
Holm, S. “Obesity Interventions and Ethics.” Arguing about Bioethics. London: Routledge, 2012. N. pag. Print.

A Nudge in the Right Direction

Humans have a natural rebellious nature because they feel entitled to control their own life. They do not wish for someone else to coerce them into doing something even if they feel that it is in their best interests. Instead, they wish to be given the chance to choose an action that is in their best interests.  When designing public health policy, it also best to limit coercion as much as possible because it will evoke more cooperation from the citizens.

Firstly, it is important to know that there are three forms of coercion: hard paternalism, soft paternalism, and maternalism. S. Holm describes hard paternalism as giving someone no option, soft paternalism as attempting to influence someone’s choice via manipulation of information, and maternalism as influencing someone’s decisions through guilt (Holland 392). Secondly, it is also important to know that no matter the circumstances, there will always be some level of outside influence on which decision a person chooses to make. The key is to make the person feel as if they have autonomously made the decision.

Obviously, hard paternalism can deter people from going through with a decision because they feel forced into their situation. D. Isaacs, H.A. Kilham, and H. Marshall assert that people “who are coerced into an action may be more likely to perceive the action as being risky than if they are persuaded into it (Holland 403). Essentially, when people are obligated to choose a default choice, they assume that there are underlying consequences that are not disclosed because these consequences will dissuade them from choosing that particular option. For instance, Simon Chapman argues that people are so hostile towards public cigarette smoking because they are forced to share the person’s toxic smoke. Nevertheless, people enjoy sitting around a warm campfire, where they, by choice, inhale its toxic smoke (Holland 408).

Meanwhile, the act of persuading, such as in soft paternalism and maternalism, forces one to unveil reasons why people should choose a certain option over other ones. This allows the person to feel that there are other options, but one particular choice is the best choice due to certain specifications. For example, educating people about the risks of obesity allows people to see that their life expectancy can be improved and their risk of disease can be lowered if they choose to diet healthily and exercise. Using soft paternalism, officials could lower insurance rates for those who live a healthy lifestyle. People still can choose to eat unhealthily, but it would not be in their best interest because they will have to spend more money to cater to a lifestyle that has been proven to shorten their lifespan. From a maternalistic approach, officials could inform parents that an unhealthy lifestyle could lead to a plethora of diseases such as asthma, diabetes, and heart disease that will lead to a poor condition of life as they grow up. Good parents should then feel guilty and thus decide to set a positive example for their children as well as ensure that their children follow this example.

Subsequently, compulsion may not be necessary in order to enact public health policy because simply giving the people an option will respect their right to choice, a key component of autonomy. One of the only instances in which compulsion may work is in a case in which a disease is immediately life threatening. This is because people value their lives and will do anything to preserve them, including subjecting themselves to mandated treatment. Still, people will view this mandate as a choice to do whatever it takes to save their life. In the end, people will comply as long as they feel that they are in control.



Chapman, Simon. “Banning Smoking Outdoors Is Seldom Ethically Justifiable.” Arguing About Bioethics. Ed. Stephen Holland. New York: Routledge, 2012. 407-11. Print.

Holm, S. “Obesity Interventions and Ethics.” Arguing About Bioethics. Ed. Stephen Holland. New York: Routledge, 2012. 392-97. Print.

Isaacs, D., H. A. Kilham, and H. Marshall. “Should Routine Childhood Immunizations Be Compulsory?” Arguing About Bioethics. Ed. Stephen Holland. New York: Routledge, 2012. 398-406. Print.



A national ideal of health: how to intervene

The growing obesity epidemic raises concerns in many sectors from healthcare to the food industry and even the business sector, and S. Holm considers the place of ethics within these conversations about interventions to combat obesity. “Obesity Interventions and Ethics” brings up the controversial debate whether health is good for everyone, regardless of individuals’ values. Similar to the conversation about informed consent, obesity interventions involve a conflict of values between autonomy, respect for personal choices, and promotion of the common good.  Current policies such as the FDA’s forced phase out of trans fats by the food industry assume that being healthy is good for all citizens.[i] Governmental control on health and health decisions could be supported by the constitutional clause on promotion of general welfare. [ii] This argument of constitutional responsibility gives broad authority to the government to promote the general welfare, and in this context, general welfare could be seen as health. This sort of argument framework has been utilized in the debate on healthcare in the United States. Our nation is making a transition towards universal healthcare by enacting the Affordable Care Act. Therefore, our government is making claims that health is an important right and aspect of citizenship. Our nation is associating health with what is “good” and society members through payments and taxes are supporting this notion by merely being members of society.

In contemporary times, personal freedom is gaining emphasis as seen in the case of informed consent, and therefore, freedom surrounding people’s choices about their health and nutrition will be increasingly scrutinized.[iii] Current times will involve interesting interchange between personal freedoms and government promotion of health for all. There are nuances between government encouraging healthy choices and controlling the choices that society members make. For example, the FDA’s forced phase out of trans fats represents governmental control, or hard paternalism as defined by Finnish philosopher Heta Hayry. There is importance in Heta Hayry’s clever distinctions between the levels of paternalism: hard paternalism, soft paternalism, and maternalism, and these differing levels could be an important marker for evaluating public health policies. Soft paternalism and materialism are the most favorable because these still allow for pursuit of personal choice.  A health campaign out of Hawaii, “Rethink Your Drink,” cultivates repugnance in soda drinkers by using controversial advertising techniques.[iv] This matneralistic  method is more favorable in terms of the consumers’ freedoms and adherence and compliance. In comparison, Mayor Bloomberg’s proposed ban on sugary drinks which was seen as an overstep of power and was not passed due to its hard paternalistic nature. Instead of instilling empowerment and change, the law was challenged and ended in a victory for soda drink makers.[v] In context to the national assumption of health as good as mentioned previously, then I do believe that these acts of soft paternalism or maternalism are justified.


I think Holm’s article makes a good point about soft paternalism and maternalism but I think there needs to be a parallel focus on issues of accessibility and affordability for good health options and information. Quality interventions should deal with these aspects, and only when these areas are covered can an individual bear all responsibility for his or her own decisions. Holm’s mentions the circular and continuous debate over who holds responsibility for the obesity epidemic. Analysis in context to the constitutional argument, the United States bears a portion of responsibility in the individual’s choice. Therefore, an appropriate and efficient intervention will need to ensure that options presented are affordable, accessible (in terms of both material items and information) as well as not presented in a controlling manner.  Environment has a huge influence on how people make decisions, and soft paternalism or maternalism interventions can only initiate movement for change if certain things, such as food options, are available or affordable or else these interventions are in vain. The “Rethink your Drink” campaign was a success because the means for the campaign are available to all—cutting out sugary drinks and replacing them with water.

Thus, in order for a soft paternalistic or maternalistic intervention to be a success people need to have the means to follow through with the behavioral changes and from there on out, the responsibility lies in the hands of the consumer. As with discussion about informed consent, from this point there needs to be respect for the consumer’s decision, especially in this ideal intervention method.  While I believe these other aspects of the intervention technique are possible, I think respect will be the largest issue in applicability. Holms highlights this issue through conversation about stigmatization; respect is difficult to cultivate when people misunderstand other’s choices and tradeoffs or an individual’s sense of well-being.

[iii] Veatch, Robert M. Abandoning Informed. Arguing About Bioethics. By Stephen Holland. New York: Routledge, 2012. 329-38. Print.



Soft Paternalism & Obesity Prevention

In Holm’s article “Obesity Interventions and Ethics” he discusses whether or not it is appropriate to have public health policies that intervene to promote a person’s health. In this essay, Holm’s focuses on obesity interventions as the public health issue. Holm states that there are two main problems with this are when and if it is actually justifiable to have such policies that intervene in order to promote someone’s health and if it justifiable to have policies that can negatively affect people but benefits the common good.

Public health policies always have a paternalistic side to them, it’s just a matter of how much paternalism a policy wants to utilize. Holm’s defines three different forms of paternalism including hard paternalism, soft paternalism and maternalism (392). All three forms use different methods, to achieve a certain end. Soft paternalism, which includes “providing unwanted information or foreclosing some options for action”, should be utilized in public health policy (Holm, 392). In this way a specific decision is not forced onto a person, however they are given the information to make better (and maybe easier) decisions about maintaining their health. Some of these policies include changing food labels and changing advertising methods.

Recently the FDA has suggested new changes to food labels in order “to bring attention to calories and serving sizes” which are important in addressing problems related to obesity. Changes include writing calories in a larger font, adjusting amount per serving, and updating the necessary daily values for various nutrients and vitamins (United States). Here is a picture of the differences between our current food labels (right) and the suggested future one (left).


The main goal of these changes is to “make people aware of what they are eating and give them the tools to make healthy dietary choices throughout the day” (United States). Changing food labels will just help people become more aware of what they are eating. Even though the label may be providing “unwanted information” people can still choose to disregard the information therefore it would benefit the common good without negatively affecting people (392).

Chile has also recently changed their food labels to be more representative of the foods contents. The Law of Food Labeling and Advertising was passed in July 2012 and focuses on regulating and labeling critical nutrients, adding warning messages to foods and reducing the amount of food marketing toward children (Corvalán, Reyes, Garmendia, Uauy, 2013).  Chile is still surveying their new changes and augmenting them, however the ideas that they suggested fall under soft paternalism. If the policies prove successful, they could be utilized in United States obesity prevention efforts.

Children are group that is often referenced in paternalism debates. The same is true in regards to obesity prevention. Children are bombarded with food advertisements while watching television, which can increase their consumption of such foods. Andreyeva found that “Exposure to 100 incremental TV ads for sugar-sweetened carbonated soft drinks during 2002–2004 was associated with a 9.4% rise in children’s consumption of soft drinks in 2004. The same increase in exposure to fast food advertising was associated with a 1.1% rise in children’s consumption of fast food” (2011). The increased associated risk may seem small, but you have to think about the number of children that it is affecting and the long-term effects of this exposure. A 2008 study found that the amount of fat on a child directly increased with fast food advertising exposure (Andreyeva, Kelly, Harris, 2011). The same study suggests that reducing the amount of exposure could reduce adiposity by 18% (Andreyeva, Kelly, Harris, 2011The evidence provided suggests that merely reducing the amount of fast food commercials directed at kids could help maintain their current and future health.

All of the solutions that I have suggested have scientific evidence behind it, and have been implemented. The policies also maintain their paternalistic roots allowing no negative consequences to be forced on anyone but simultaneously is improving the health of the general public.


Andreyeva, T., Kelly, I.R., Harris, & J.L. (2011). Exposure to food advertising on television: Associations with children’s fast food and soft drink consumption and obesity. Elsevier, 9(30): 221-233.

Coravalán, C., Reyes, M., Garmendia, M.L., & Uauy, R. (2013). Structural responses to the obesity and non-communicable diseases epidemic: the Law of Food Labeling and Advertising. Obesity Reviews, 14(2): 79-87. Doi: 10.1111/obr.12099.

Holm,S. Arguing about Bioethics. Ed. Stephen Holland. Routledge: New York, NY, 2012. Print.

United States. U.S. Food and Drug Administration. Nutrition Facts Label: Proposed Changes Aim to Better Inform Food Choices.






New Tools for Childhood Immunization


The concept of childhood immunizations may seem exhausted to us now, given the number of discussions we’ve held on the subject. However, I find that Isaacs, Kilham and Marshall, in their paper Should Routine Childhood Immunizations be Compulsory?, do an excellent job of wholly representing convincing arguments for both sides as well as bringing up a few aspects of the debate that we have yet to discuss.

One subject that we have touched on briefly in class, the risk of injury from the vaccination versus the risk of injury if not vaccinated, is again mentioned here, but this time more in depth. Isaacs et al. provide actual numbers. For example, the routine measles vaccination “causes acute encephalitis with an incidence of one in a million doses” where as the risk of acute encephalitis if the person was to naturally be infected with measles, or the “wild-type infection”, is one in a thousand (399). This is a huge difference. I think it’s very important for this kind of comparative information to be presented to parents and the general public as part of an educational effort. If these are the crude facts, why do parents (assuming that they have this information) still say no to vaccinations? Isaacs et al. offers psychological reasoning that there is a tendency for parents to be more afraid of causing harm to their children because of something they actively did than because of something they didn’t do. “This is referred to as the fear of commission rather than of omission” (400). I think this is a very salient concept that is important for doctors to be aware of when discussing immunization with parents. In a moving quote from Benjamin Franklin, after the death of his son to smallpox after having not vaccinated him, Franklin proposes that regret is the same either way, and so the safer route (immunization) should be chosen (400).

Another topic we have discussed in regards to immunizations is the concept of free-riders and herd immunity. Once again, Isaacs et al. provides very vital information on the subject. Free-riders are those who opt out of immunizations under the impression that enough of the population will have gotten the vaccination that they will be protected from infection without needing to vaccinate themselves or their child. The issue that we haven’t discussed yet, however, is that there are known, calculated disease-specific percentages of the percentage of the population that needs to have been immunized for herd immunity to work. Going back to the example of measles, it is known that 95% of the population has to have received the measles immunization to ensure that no outbreaks will occur (401). For Hib disease, the percentage is slightly lower at 85%, but this only guarantees that rates will begin to rapidly decline (401). These percentages are an excellent tool for doctors to be equipped with when interacting with a “free-rider” parent. The doctor can then confidently tell them whether or not there is currently a sufficient amount of people immunized for their plan to work. Certainly though, there will be doctors who won’t care that these percentages have been reached and will still push for the parent to immunize, as I think the doctor should. But then the ethical question arises of whether the doctor is in the right to do so if the vaccination may not actually be necessary. Ethics would most likely find that at that point, the parent is ok not to vaccinate.

One last issue that I think Isaacs et al. did well to bring up is the idea of inducements instead of punishments to encourage child immunization. There has historically been, and currently been talk of, jail time as a punishment for refusing to immunize your child because you are not acting in the best interest of the child. However, putting the parent in jail certainly would not be in the best interest of the child, so realistically that is not an option. However, they offer the suggestion of child care benefit payments or maternity benefit payments to encourage parents to immunize their children. They also mention those families who rely on welfare. I think it is not only a great idea, but arguable as well. Why not require all children who receive Medicaid to be immunized? Isaacs et al. offer this idea, saying “if society provides child and family payments, it is reasonable for society to expect and even demand that children be immunized to help protect the whole community” (404).


Isaacs, Kilham, and Marshall. “Should Routine Childhood Immunizations be Compulsory? Holland, Stephen. Arguing About Bioethics. 398-406.

The “When” of Libertarian Paternalism

The reading on “Libertarian Paternalism” takes a concept that has for years been seen in a negative light and gives it a positive spin (Thaler and Sunstein). When discussing the history of health care and public health in America especially, the concept of paternalism is typically thrown around in tones of disgust and shame. Authority figures in the realm of health aren’t qualified to decide what is best for us—only we are capable of making those decisions.

In our discussions surrounding informed consent and autonomy, we continuously mulled over whether or not health care professionals have the right to make decisions or even narrow down treatment options for patients. I have come to the conclusion that they largely do have this authority and duty. Though the model of the doctor/patient relationship could use some serious work, patients do not need to know about each option available to them; being informed is important, but doctors are capable of narrowing down treatment options without full patient partnership.

Thaler and Sunstein take this question of the morality of paternalism to a different level. They use examples of a less immediate nature such as retirement plans and cafeteria layouts to illustrate the unavoidable nature of paternalism and just how beneficial it can be, suggesting that we not focus on whether or not paternalism is right in certain cases but how to choose the best paternalistic options.

Though the examples they use are simple, I believe Thaler and Sunstein have a point regarding paternalism in public health. People will most often do what is best for themselves. Public health is the improvement and maintenance of the health of communities, not the individual—thus it is not beneficial to rely upon individuals to make effective decisions in public health.

What is interesting to me, though, is that this argument can then stand as a counterargument in the informed consent and autonomy debate. If individuals do what is in their own interests, isn’t it then moral to leave health care decisions fully up to them? It would seem that if one asked Thaler and Sunstein, the answer would be yes. However, although I am convinced of their argument for paternalism in public health, I believe libertarian paternalism can also be applied to treatment decisions in health care.

Individuals are—to an extent—capable of deciding what is best for them; but in the realm of health care, there is a lot of knowledge that professionals have access to that the average person does not. Even with thorough information—it is difficult for patients to make these sometimes life altering decisions. What is so wrong with a little libertarian paternalism? As Thaler and Sunstein mention in their essay, in everyday situations in which this type of paternalism is used, it is because the people do not want to undergo the hassle of making an initial decision themselves, or they feel as though they are not specialized enough in the matter to make the appropriate decision on their own.

Though I have never before viewed paternalism positively, I believe this essay makes a sound argument for it. This does not mean that paternalism is good; it just means that there are several situations in which it is conducive to efficiency and genuine well-being which should make it acceptable.

Thaler, Richard H., and Cass R. Sunstein. “Libertarian Paternalism.” Arguing About Bioethics (2003): loc.  10829-10968. Print.

Investing in Lives

Healthcare, like many “public” services, is not equally available to everyone. It is true that there is some degree healthcare available to the population at large, but, due to the private sector, the quality is vastly different between groups. There are many things that factor in to the availability of quality healthcare. Things such as income, race, ethnicity, gender, age and others all play in to the healthcare a person receives. A complete list is covered in a report on health disparities published by the CDC  ( These factors ultimately come down to income and demographics. Preventive medicine deserves a larger amount of funding. If everyone does not have the same opportunity to protect their health, then should they be placed with the total responsibility of their own preventative medicine?

Education is a public service, but you can pay for better education; a higher level of learning to obtain a higher standard of living. Health care is also public, but again private healthcare is where the highest quality of care is generally found. Not because doctors are better, but because there are more resources and fewer patients. Preventative healthcare is no different in its access. There are many forms of public “prevention” that we may not even be aware of. Regulation of water, food, and air are a few things that prevent us from getting sick. For the US, these are the lowest level of prevention services provided. Beyond those things, availability of health prevention is not equal. In his argument Preventive Medicine, Brody states that “preventive medicine is most easily amenable to equal distribution”. At a basic level this is true, but to a greater extant preventative medicine is not equal.

One of the salient aspects in prevention is diet. It also happens to be one of the largest contributors to the prevalence of many chronic diseases in the US (WHO). Things such as food deserts and the limited influence and quantity of food stamps are directly related to income. When a family has a limited budget, and a bag of chips is cheaper then an apple, junk food trumps nutrition. Diet is an example of prevention that is not equal.

Like Brody mentions in Preventive Medicine, as a society we are more likely to fund life saving procedures then to invest in projects that will save lives before they are at risk. Nobody wants to pay you to keep them from getting sick. However, the cost of prevention is much less. Vaccines are a perfect example of how a small amount of money can save more lives if it is invested before those lives need to be saved.

With this information—of the cost benefits of acting early on health prevention and the disparity that currently exists in the US—can we raise the level of “basic” preventive medicine? Is it ethical that some people have the capacity to “protect” their own health through diet and other means, and others fall short? Why shouldn’t there be a larger public investment in preventative medicine, so that it may influence a larger population, ultimately saving money down the road?


WHO website

CDC Health Disparities & Inequalities Report (CHDIR)—Morbidity and Mortality Weekly Report (MMWR)


Book Title: Bioethics: Readings and Cases. 298-301. Prentice-Hall.1987

ISBN: 0130765228

Libertarian Paternalism: Helping Guide People in the Right Direction

Libertarian Paternalism: Helping Guide People in the Right Direction

Libertarian paternalism captures the combination of behavioral economics and paternalistic guidance.  Thaler and Sunstein define libertarian paternalism as guiding people to make an ideal decision without coercion or force.  A shortcoming of this concept is that many people falsely assume: 1.) there are viable alternatives to paternalism and 2.) paternalism always involves coercion (Thaler, Sunstein 386).  In the following paragraphs, I am going to refute these assumptions with demonstrations of necessary paternalism.

Firstly, libertarian paternalism can be well portrayed in the example created by Thaler and Sunstein in Behavioral Economics, Public Policy, And Paternalism: Libertarian Paternalism.  In summary, a cafeteria director realized that the order in which his food was arranged influenced consumer decisions.  So, what should the director do in order to change this problem?  This is when the concept of paternalism comes into play.  He could arrange the food so the healthiest options are more likely to be chosen, he could do the exact opposite, or he could choose randomly.  The director clearly has to make a choice here, so there are no other viable alternatives to paternalism.  Also, the director choosing the first option makes the consumers better off, without actually forcing any change in behavior (Thaler and Sunstein, 386).  Therefore, both false assumptions are not applicable to this situation.

Another example of libertarian paternalism is the program; Weight Watchers, which helps overweight people shed pounds and become healthier versions of them selves.  Occasionally, caring family members sign an unhealthy member up for Weight Watchers without their actual consent.  Does this constitute coercion or libertarian paternalism?  I believe signing up a family member in need does not constitute coercion, because they stand the right to refuse service and Weight Watchers would only make the subject better off.  If the subject is at risk for heart disease due to his/her obesity, then there are no viable alternatives and both false assumptions can be refuted yet again.

Finally, the concept of libertarian paternalism is directly correlated to many of the extreme medical dilemmas we have discussed in class.  For example, the earlier discussion of autonomous patients who are unsure if they want to proceed with treatment correlates to a physician’s usage of libertarian paternalism (Brody and Englehardt, 285).  Since the physician has the patient’s best interest in mind and cannot use coercion, (at least in fully autonomous situations) he might try to lead the patient in the most beneficial direction.  Also, when a patient is on his/her deathbed, there are normally no other viable options; therefore, disproving the false assumptions.

Overall, libertarian paternalism should not be immediately viewed as coercive and not allowing for individuality.  The previous three examples demonstrated a non-forceful, paternalistic approach with no other viable options; therefore, I think libertarian paternalism is necessary in many situations.

Works Cited:

1.)    Thaler, Richard H., and Cass R. Sunstein. “Behavioral Economics, Public Policy, And Paternalism: Libertarian Paternalism.” Arguing about Bioethics. By Stephen Holland. London: Routledge, 2012. 386. Print.

2.)    Brody, Baruch, and Tristram Englehardt. “ReservesDirect Login.” ReservesDirect Login. Prentice-Hall, 1987. Web. 24 Mar. 2014. <>. 285.

Sacrificing Individualism for the Sake of Individualism

          In defense of public health law, Lawrence O. Gostin argues for more spending on public health resources. He finds that over the course of history, society has promoted individualism at the expense of public health services (374). Gostin uses the recent threats of bioterrorism as a reason why we should be more concerned with introducing more stringent and uniform state and local public health laws. The article might have held even more weight had Gostin referenced the 1989 public health fiasco concerning the Reston virus. Today’s film industry seems to be in love with movie plots featuring deadly viruses that lead to quarantine and panic; however, these fictional tales we often see only in the movies do have some grounding in reality. Richard Preston, a writer for the New Yorker and best-selling novelist, knows all too well about the real possibility of viral outbreak in the U.S. In 1992, Preston published an article about the Reston virus scare, which originated in Reston, Virginia. The true story stems from disease research on primates. Monkeys are imported to the U.S. from all over the world and are lab testers for potential cures to deadly viruses. In 1989, a shipment of macaque monkeys was moved from the Philippines into the U.S., and strangely many of them began to die (62-65). After a series of misdiagnoses of what was affecting the monkeys, researchers came across a strain of Ebola that had never been seen before (73). This caused immediate panic within the facility as it was yet unknown how the discovered strain of Ebola would affect humans. Eventually it was found that while the virus was harmful to monkeys, it could not harm humans, though it can successfully reproduce in the human body (79). Overall though, Preston’s article shows the very real potential of fatal viruses making their way into the U.S.

          After the outbreak of the Reston virus, the Institute of Medicine published a paper about emerging infections and the growing threat of mutant bacteria (Preston, 80). Seeing how the Ebola virus and many other viruses cause fatalities worldwide should pressure the U.S. and individual states into taking greater care about health-scare preparedness. As Preston states in his article, “the presence of international airports puts every virus on earth within a day’s flying time of the U.S.” (62).  Just the existence of a potential for outbreak means we should be doing everything that we can to prevent it, as well as to prepare for it. As Gostin states in his piece, it is not about passing legislation that will necessarily work, but rather passing legislation that is stronger, better, and more effective than what we currently have (378).This means having to sacrifice some personal rights in the state of a public emergency. Without these precautions, we actually threaten the exercise of autonomy, as well as endanger human beings. So, it might be necessary to give up what we think of as individual rights in times of emergency, for the greater good of protecting future autonomy and individual rights.


Works Cited

Gostin, L.O. “Public Health Law in an Age of Terrorism: Rethinking Individual Rights and Common Goods.” Arguing About Bioethics. London: Routledge, 2012. 374-384. Print.

Preston, Richard. “Crisis in the Hot Zone.” The New Yorker. Oct. 26, 1992. 58-81.

The Weight of Paternalism on the Public Health Scale

In Public Health Law In an Age of Terrorism: Rethinking Individual Rights and Common Goods, Gostin examines public health law and the deficiencies associated with the current policies. He claims that there has been little emphasis on modernizing the laws to accommodate the recent advances in public health and constitutional law (Gostin 374). “Reform of public health law is essential to ensure that public health agencies have clear missions and functions, stable sources of financing, adequate powers to avert or manage health threats, and restrains on powers to maintain respect for personal rights and liberties” (Gostin 374-375).

During his argument, he challenges critic’s concerns about personal libertarianism and the protection of personal rights in the event of a national wide medical emergency.  For Gostin, compulsory power is necessary for public health because the government has the right to prevent individuals from endangering others. “The state undoubtedly needs a certain amount of authority to protect the public’s health” (Gostin 381). This action obviously compromises the individual’s autonomy in certain situations and creates moral concerns for authorities.

In addition to his argument, I think it’s important for critics to recognize how these policies come into play and who writes them. As Americans, we have the civil liberty to vote for policy makers, state representatives and even the passage of certain laws. While the individual’s current right may be undermined at the time of an emergency, they have the capacity to exercise their personal liberty in voting for state representatives and legislative officials.

You cannot remove paternalism from public health. As Thaler and Sunstein have pointed out, “some kind of paternalism is likely whenever such institutions set out arrangements that will prevail unless people affirmatively choose otherwise” (Thaler and Sunstein 390). The public voted for such regulations and must comply with them accordingly. In the realm of public health policy we often forget where the law initially stems from. It’s the people.

As citizens, we have the ability to exercise our autonomy towards choosing which paternalistic approach we like the most; perhaps it’s the one that promotes the most personal freedom. Regardless of the policy outcome, paternalism and public health go hand in hand.


Thaler, Richard H., Sunstein, Cass R. “Behavioral Economics, Public Policy, and Paternalism: Libertarian Paternalism.” Arguing About Bioethics. London: Routledge, 2012. 386-391. Print.

Gostin, L.O. “Public Health Law in an Age of Terrorism: Rethinking Individual Rights and Common Goods.” Arguing About Bioethics. London: Routledge, 2012. 374-384. Print.